It has been described as the biggest calamity to befall the world in human history. Others call it the disease (as if other illnesses aren’t diseases). It is HIV/AIDS. In Africa alone, 25 million people would be alive were it not for this pandemic that spread like a bush fire two decades ago. Author Robert Guest of The Shackled Continent writes about it as one of the lead factors that have conspired with politics to keep Africa poor.

Book: Psychiatric Problems of HIV/AIDS and their Management in Africa Editors:  Seggane Musisi and Eugene Kinyanda Publisher: Fountain Publishers Kampala Publication: 2009 Reviewer: Allan Mwesiga and Yusuf Serunkuma

Most unfortunate, this pandemic is more often presented with a focus on those infected and only rarely is attention directed to the affected people.

Peter Mugyenyi’s Genocide by Denial notes how work often came to halt in most Kampala offices and on farms in the countryside when people went for burial and could not move away from the burial grounds because another relative, neighbour or friend would die before departure. And how offices instead had to issue memos directing staff to only attend burials of only the closest and immediate family members; and how men would sneak away at night to return to their workplaces inundated by the endless stream of HIV/AIDS burials.

This book is a product of efforts of authors from a cross section of professions: Psychiatry, Medicine, Law, Gender Studies, Public Policy and Health Workers’ Advocacy groups. It addresses, in the main, the psyche of anyone in residence or neighbourhood of HIV/AIDS. It is packaged in a redemptive manner.

All the papers collected in this book start with a thorough understanding of the magnitude of mental disorder that HIV/AIDS has had on Africa. Issues ranging from psychological reactions on realisation of infection, emergent psychiatric disorders in individuals and special groups are dealt with. Acute HIV related stress, suicidal behavior, anxiety, depression, delirium and frustration expressed through the choice to abuse drugs are highlighted.

It points out that issues of “the psychiatric and behavioural problems associated with HIV/AIDS and their management” are often underemphasised. We may try to ask: Does suffering from HIV/AIDS result into madness; does caring for the sick result into some form of sickness, and how about living in the AIDS battlefield — of widows and orphans, stigmatised hands that have turned into wanderers or unemployed slackers?

Many households are headed by children, commercial sex/survival sex is still high; casual sex alongside rape, which all have high percentage of vulnerability and can facilitate the transmission of HIV/AIDS continue to define lifestyle in Uganda — all occasion damage to the psyche.

The strength of this book is derived from life as its comprehensiveness, on both the specific area of HIV/AIDS, and the general area of administering health care — especially when dealing with fatal illnesses. It addresses all the endangered species but with emphasis on the most vulnerable- women, adolescents, orphans and the old.

Its pragmatism is the other issue that can’t go unnoticed. The scholars and medical practitioners stress that provision of antiretroviral therapy alone is not enough, it must be backed up with counselling and material care and better policies. What else is more heartwarming than a suggestion to have a National Orphan Policy, with a well established National Orphan Registry, with clearly communicated guidelines for caretakers?

This book doubles as a self help guide to anybody and a much friendlier manual for people in the business of medical care. It gives specification to medics and patients on how to address complex issues such as which medicine is appropriate and how to give it. Further, the picture and manifestation of the scourge is given to anyone with vivid clarity — as a mechanism for self protection. 

As many productive youth are endlessly lowered in the ground, and the continent sinks further into poverty, the book presents the most needed insights for both behavioural and policy change. It addresses the most painful psychosocial issues around HIV/AIDS. It makes it clear that there’s life and productivity after infection — an issue that has often eluded most African communities.

This is a timely text as the country is once again grappling with a rising HIV prevalence rate and rising cases of psychiatric illness.  The challenges facing the management of HIV/AIDS related psychiatric problems are for the most part limited funds and limited treatment options. Policy gaps still exist especially on AIDS orphans. There is still hope for more holistic care with the greater acceptance of the role of traditional and faith healers.

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